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Background: Iliopsoas abscess, though usually presents with innocuous features, may sometimes complicate the clinical course with neurologic complications or hyperacute symptoms. Occasionally it may extend to the epidural space causing the surgical emergency of cauda equina syndrome, with clinical symptoms of saddle anesthesia, motor and sensory dysfunction of lower limbs, as well as bowel/bladder dysfunction. Case report: We present the case of a patient with iliopsoas abscess who presented with acute low back pain and radiculopathy, which over a period of few hours progressed to incomplete cauda equina syndrome. The patient was managed with urgent posterior decompression of the communicating epidural abscess and drainage of iliopsoas abscess. At final follow-up of one year, complete resolution of neurological deficit was evident. Conclusion: Iliopsoas abscess, depending upon the virulence of the causative microbe, may rarely extend to the epidural space causing surgical emergency of cauda equina syndrome. Urgent surgical decompression of nerve root and dural sac, and evacuation of pus can yield satisfactory clinical outcome. Level of evidence: Level V.